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Medicine As Techne – a Perspective from Antiquity

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Medicine As Techne – a Perspective from Antiquity Journal of Medicine and Philosophy 0360-5310/03/2804-403$16.00 2003, Vol. 28, No. 4, pp. 403–425 # Swets & Zeitlinger Medicine as Techne – A Perspective from Antiquity Bjørn Hofmann University of Oslo, Oslo, Norway ABSTRACT The objective of this article is to investigate whether the concept of techne is fruitful as a framework to analyze some of the pressing challenges in modern medicine. To do this, the concept of techne is scrutinized, and it is argued that it is a concept that integrates theoretical, practical and evaluative aspects, and that this makes it particularly suitable to analyze the complex activity of modern medicine. After applying this technical framework in relation to modern medicine, some of its general consequences are elaborated. In particular, it is argued that the concept of techne is appropriate to address the constitutive role of technology in medicine. Techne thus appears to be as fruitful a philosophical concept today as it was in antiquity. Keywords: ethics, practice, techne, technology, theory I. INTRODUCTION Modern medicine faces fundamental epistemological, ethical and practical challenges. How are we to understand and face these challenges? This article will try to find a theoretical framework for addressing this issue. In particular, it will scrutinize an approach that addresses one of the foremost characteristics of modern medicine: its extensive and constitutive use of technology. There appear to be many alternative frameworks for facing the challenges of modern medicine. Various theories and models in health care management, in organizational theory or in philosophy have been applied. Some promising approaches refer to ancient conceptions to face the fundamental challenges of modern medicine. For example, one approach has focused its attention on the ancient concept of practical wisdom (phronesis) (MacIntyre, 1985; Pellegrino, Address correspondence to: Bjørn Hofmann, Ph.D., Faculty of Medicine, Center for Medical Ethics, University of Oslo, PO Box 1130, N-0318 Oslo, Norway. E-mail: b.m.hofmann@ medetikk.uio.no 404 BJØRN HOFMANN 1979; Pellegrino & Thomasma, 1981, 1993). An alternative approach, referring to another of the ancient intellectual virtues, conceives of medicine as an art (techne). Contemporary commentators have followed the author of On the art (Peri techne) insisting that medicine is an art. In particular it has been argued that medicine as an art is opposed to medicine as a science (Gadamer, 1993; Gillies, 1996; Jonas, 1985; Robinson & Bevan, 1993), and that there is a basic dichotomy in medicine where the subjective, evaluative, particular and intuitive, opposes the objective, factual, general and rational. However, few of these theories appear to address the pertinent position of technology in modern medicine. Both theories based on phronesis and theories supporting the art-science distinction seem to rule out technology as a constitutive aspect of medicine. This appears to be problematic, as technology seems to be at the heart of both the rise and the fall of modern medicine (Le Fanu, 1999). The objective of this analysis will therefore be to investigate whether the ancient conception of medicine can be fruitful as a model for modern medicine. In particular, I will scrutinize whether such a conception can address the puissant position of technology in medicine. In order to do this I will begin with the claim of the author of On the art, that medicine is an art, and ask: what is techne? I will start to scrutinize the concept of techne in general and the concept of techne iatrike in particular. This will be done in order to see whether the concept can be applied to analyze actual challenges in modern medicine, and to outline some general consequences of such a technical theory of medicine. In particular I will investigate how this approach addresses the challenges of technology in medicine. II. THE HIPPOCRATIC CONCEPT OF TECHNE Although there is an extensive scholarly debate, there appears to be a fair agreement on some key characteristics of the pre-Aristotelian concept of techne. To avoid highly interesting, but complex conceptual controversies, I will take these key characteristics as a point of departure. i. Techne is knowledge of a specific field. That is, it has a determined subject matter and studies the nature of this subject matter. ii. Techne is oriented to a specific end. iii. Techne produces a useful result. iv. Techne requires mastery of general rational principles that can be explained and therefore taught.1 MEDICINE AS TECHNE 405 In short, techne ‘‘is a deliberate application of human intelligence to some part of the world, yielding some control over tuch^e [accident]’’ (Nussbaum, 1986, p. 95). How then do these characteristics of techne correspond to the ancient concept of medicine? According to the main conception of the Corpus Hippocraticum, techne iatrike is characterized as follows: 1. The specific subject matter of medicine is the diseased human body. 2. The end of medicine is to heal and to help the patient. 3. The product of medicine is health for the individual patient. 4. Medicine investigates its general principles and gives a rational account of its actions. Before I turn to investigating whether such a concept of techne can be of any relevance to modern medicine, let me scrutinize these characteristics in some detail. A. The Subject Matter of Medicine Medicine had limits determined by the nature of its given subject matter (pragma)(On the art VIII; Regimen in acute diseases 39; Prognostic I; Edelstein, 1994, p. 106). Thus, the subject matter, and thereby the limit of medicine, was the diseased body. Physicians who did not recognize this limit of the medical profession were physicians in name only (Edelstein, 1994, p. 102). ‘‘If a man demand from an art [techne] a power over what does not belong to the art ...his ignorance is more allied to madness than to lack of knowledge’’ (On the art VIII). The limitation to its subject matter had some practical consequences. Firstly, medicine was a study of soma and did not include treatment of the soul or the good life in general.2 Secondly, the physician should refuse to treat desperate cases where the disease was too serious or had progressed beyond the possibility of cure. Medicine should keep within its domain and ‘‘refuse to treat those who are overmastered by their diseases’’ (On the art III 10).3 Hence, the subject matter represented a delineation of medical activity, being an element in a tradition of self-limitation (Prognostics I).4 B. The End of Medicine Furthermore, medicine was characterized by its end: to heal and to help the patient (On ancient medicine III; On the art VI; The oath). The author of On the art argues that techne iatrike ‘‘is to do away with the sufferings of the sick, [and] to lessen the violence of their diseases’’ (On the art III 8-9). The end of 406 BJØRN HOFMANN medicine was to rid the patient of the evils of the body, such as weakness (asteneia), ugliness (aiskos), and sickness (nosos). Without this goal techne iatrike would not be a legitimate activity. The physician, like all other craftsmen, had a purpose: to re-establish bodily order (kosmos), i.e., health and strength.5 Contrary to the intervention and manipulation of modern medicine, the task of the ancient physician was to recognize disease and assist (therapeuein) nature in its natural healing capacity (vis mediatrix naturae, katastasis).6 Medicine was a result of the necessity to help (Longrigg, 1993, pp. 102- 103). As stated in The oath: ‘‘I will use treatment to help the sick according to my ability and judgement, but never with a view to injury and wrong-doing’’. Medicine was concerned with the good of the human body. The love of man made the physician love his art (Precepts VI).7 The end of medicine was not only the patients and their bodies in general. Its aim was to fulfil the needs of a particular patient (Regimen in acute diseases IX) and to take into account the particular situation (On ancient medicine XI; XII). It was medicine’s concern for the sufferings of the individual person that made it a techne (Jaeger, 1989, p. 543). The physician was not only to know how the pharmakon influenced the body in general, but also how it acted on the particular patient (On ancient medicine XX).8 Hence, the end of medicine was not the universal, but the particular (Gadamer, 1993, pp. 11–49). The reason for this relationship is that the techne iatrike related to its subject matter in a special way (Jonas, 1985, p. 149). The subject matter of medicine was at the same time its end: the diseased human body. In bringing the body back to its equilibrium and order medicine displayed its end (Jonas, 1985, p. 146). C. The Result of Medicine Medicine was also characterized by having a defined result (ergon)(Precepts II) and the result of medicine was health (See also (Charmides, 165d1-d2; 166a3-7; Republic I, 346d). Health was conceived of as bodily balance, arrangement and order. It was its productive activity that granted medicine its paradigmatic status as techne. It was the product of its activity, rather than its argumentation, which counted (Edelstein, 1994, p. 103), and the result of therapeia was related to the end of medicine. In the same manner as medicine’s end was not patients in general, health was not a general result, but a particular product related to the individual patient. MEDICINE AS TECHNE 407 Furthermore, it was the productive trait of ancient medicine that made the author of On ancient medicine reject the monistic theories of the natural philosophers. Disease could not be explained and treated by monistic laws of air (Diogenes of Apollonia) or water (Hippon of Samos) (Longrigg, 1993, pp.
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